title: Risk of adverse gastrointestinal events from inhaled corticosteroids.
abstract: OBJECTIVE
  To determine whether patients prescribed inhaled corticosteroids are at risk for adverse gastrointestinal effects.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Urban health center with an academic affiliation.
  
  
  METHODS
  A total of 19,443 adults (mean age 31.8 yrs) with airways disease, defined as a diagnosis of asthma or chronic obstructive pulmonary disease, and who were prescribed both an inhaled corticosteroid and albuterol (7156 patients) or inhaled albuterol alone (12,287 patients) between November 1977 and February 2002.
  
  
  RESULTS
  The frequency of adverse gastrointestinal events in the patients who used inhaled corticosteroids and albuterol was compared with that in the patients who used albuterol alone. Adverse gastrointestinal outcomes included events such as gastritis, ulcers, and bleeding. Cox proportional hazards models were used to determine the risk of adverse events, controlling for possible confounders such as alcohol use or nonsteroidal antiinflammatory drug use. Adverse gastrointestinal events were observed in 461 (6.4%) patients using inhaled corticosteroids and albuterol and in 302 (2.5%) patients using only albuterol. After controlling for potential confounders, patients who used inhaled corticosteroids and albuterol had an increased risk for adverse gastrointestinal events compared with patients who used only inhaled albuterol (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.02-1.56). A prescription for a spacer device reduced this risk among patients using an inhaled corticosteroid (HR 0.26, 95% CI 0.20-0.34).
  
  
  CONCLUSIONS
  Patients using inhaled corticosteroids appear to have a slight risk for adverse gastrointestinal events that is mitigated in patients who used a spacer device.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, School of Pharmacy, Chapel Hill, North Carolina 27599-7360, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.forename: Jane
authors.initials: J
authors.lastname: Wang
authors.forename: Roberta
authors.initials: R
authors.lastname: Ambuehl
authors.forename: Clement J
authors.initials: CJ
authors.lastname: McDonald
authors.forename: Michael D
authors.initials: MD
authors.lastname: Murray
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D000420:Albuterol